Hypertensive disorders of pregnancy, defined as a group of diseases including preeclampsia, eclampsia, gestational hypertension, and chronic hypertension, are one of the greatest causes of perinatal morbidity and mortality and affect 1 out of every 10 pregnancies in the United States. Hypertension in pregnancy increases lifetime cardiac disease risk by 2-4X and is considered an independent, gender-specific cardiovascular risk factor by the American Heart Association. Treatments of hypertension in pregnancy are extremely limited and include watchful waiting, antihypertensive medications, or ultimately, early delivery. Controlling blood pressure in pregnancy may be complicated by fear of teratogenicity, controversies regarding tight versus less tight control, increased risk for intrauterine growth restriction, congenital heart defects, and placental abruption with some pharmacotherapeutic options.

Mindfulness training holds great potential as an innovative and effective non-pharmacological intervention to prevent hypertension in pregnancy. No studies have evaluated mindfulness training as an intervention to prevent hypertension in pregnancy despite evidence that: 1) in non-pregnant adults, mindfulness training improves cardiovascular functioning and parasympathetic activity, 2) mindfulness training regulates blood pressure among adults with prehypertension and hypertension, and 3) higher trait levels of mindfulness are associated with lower resting blood pressure in healthy pregnant women.

In this CardioPulmonary Vascular Biology COBRE pilot study, we propose to randomly assign N=30 pregnant women with histories of hypertension in a prior pregnancy to a prenatal mindfulness intervention + usual care, or to usual care alone. The primary aim of this study is to examine differences in pathophysiological mechanisms underlying recurrence of hypertensive disorders of pregnant among women receiving mindfulness training versus usual care. The second aim is to examine differences rates of recurrence of hypertensive disorders of pregnancy among women who complete a mindfulness training intervention versus usual care. Our central hypothesis is that mindfulness training will reduce inflammation and improve endothelial function, thus resulting in decreased uterine and systemic vascular resistance and concomitant improvements to blood pressure and hypertensive disease.